Treatment of rectal cancer varies on the presence of distant organ metastasis. Tuberculous lymphadenitis is a microbial disease involving mediastinal lymph nodes and may heal with anti-tuberculosis treatment. The coexistence of these two situations may lead to misunderstanding of lymphadenitis as metastasis of rectal cancer and end up with the wrong treatment strategy. We present an exemplary patient eliciting the importance of the correct diagnosis in planning the treatment.